One-Year Outcomes of Major Adverse Cardiac Events in Patients with ST-Segment Elevation Myocardial Infarction Who Received Delayed PCI in a Type-B Hospital

Nova Maryani; Gagah Buana Putra; Farhan Hanifati; Muhammad K. Abdillah

doi:10.30701/ijc.2038

Nova Maryani, MD Department of Anaesthesiology and Intensive Therapy Medicine, Faculty of Medicine, Universitas Muhammadiyah Yogyakarta, Indonesia https://orcid.org/0000-0002-4333-7549
Gagah Buana Putra, MD Department of Internal Medicine, Faculty of Medicine, Universitas Muhammadiyah Yogyakarta, Indonesia
Farhan Hanifati Faculty of Medicine and Health Sciences, Universitas Muhammadiyah Yogyakarta, Indonesia
Muhammad K. Abdillah Faculty of Medicine and Health Sciences, Universitas Muhammadiyah Yogyakarta, Indonesia

DOI: https://doi.org/10.30701/ijc.2038

Keywords: Delayed PCI, MACE, STEMI, Type-B Hospital

Abstract

Background: Delayed Percutaneous Coronary Intervention (PCI) remains common in resource-limited hospitals due to system-related delays, often resulting in prolonged ischemic time. Although early reperfusion is the standard of care for ST-segment Elevation Myocardial Infarction (STEMI), delayed PCI may still be performed in selected, clinically stable patients. This study aimed to evaluate the one-year incidence of Major Adverse Cardiac Events (MACE) among STEMI patients undergoing PCI in a Type-B hospital, where delayed PCI was the predominant treatment pattern.

Methods: This retrospective cohort study included adult STEMI patients who underwent PCI at PKU Muhammadiyah Gamping Hospital, Yogyakarta, Indonesia, between September 2018 and December 2020. Patients with incomplete medical records or loss to follow-up were excluded. Baseline clinical characteristics, comorbidities, infarct location, and door-to-wire-crossing time were collected. MACE included all-cause mortality, acute pulmonary edema, non-ST-segment elevation myocardial infarction, stroke, and rehospitalization due to reinfarction or acute heart failure within one year after PCI. Kaplan-Meier survival analysis and Mann-Whitney testing were applied.

Results: Among 130 STEMI patients who underwent PCI, 123 (94.6%) received delayed PCI, with a median door-to-wire-crossing time of 10 hours 34 minutes. During one-year follow-up, MACE occurred in 10 patients (7.7%), corresponding to a 92.3% event-free survival rate. No significant association was observed between door-to-wire-crossing time and one-year MACE (p = 0.927).

Conclusions: In this single-center study conducted at a Type-B hospital, one-year MACE occurred in 7.7% of STEMI patients undergoing PCI, most of whom received delayed PCI. No significant association was observed between door-to-wire-crossing time and MACE occurrence. Given the observational design and the limited number of events, these findings should be interpreted with caution. Delayed PCI appears feasible in selected patients, but should not be considered equivalent to guideline-recommended early PCI.

Downloads

Download data is not yet available.

References

1. Janssens GN, Van Der Hoeven NW, Lemkes JS, Everaars H, Van De Ven PM, Marques KMJ, et al. 1-Year Outcomes of Delayed Versus Immediate Intervention in Patients With Transient ST-Segment Elevation Myocardial Infarction. JACC Cardiovasc Interv. 2019 Nov;12(22):2272–82.
2. Kocayigit I, Yaylaci S, Osken A, Aydın E, Sahinkus S, Can Y, et al. Comparison of effects of thrombolytic therapy and primary percutaneous coronary intervention in elderly patients with acute ST-segment elevation myocardial infarction on in-hospital, six-month, and one-year mortality. Arch Med Sci – Atheroscler Dis. 2019;4(1):82–8.
3. Otaki Y, Watanabe T, Goto J, Wanezaki M, Kato S, Tamura H, et al. Association between thrombolysis in myocardial infarction grade and clinical outcome after emergent percutaneous coronary intervention in patients with acute myocardial infarction who have suffered out-of-hospital cardiac arrest: the Yamagata AMI registry. Heart Vessels. 2022;37:40–9.
4. Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ, Cushman M, et al. Heart Disease and Stroke Statistics—2016 Update. Circulation. 2016;133(4).
5. Dharma S, Andriantoro H, Dakota I, Purnawan I, Pratama V, Isnanijah H, et al. Organisation of reperfusion therapy for STEMI in a developing country. Open Heart. 2015 May;2(1):e000240.
6. Greulich S, Mayr A, Gloekler S, Seitz A, Birkmeier S, Schäufele T, et al. Time‐Dependent Myocardial Necrosis in Patients With ST‐Segment–Elevation Myocardial Infarction Without Angiographic Collateral Flow Visualized by Cardiac Magnetic Resonance Imaging: Results From the Multicenter STEMI‐SCAR Project. J Am Heart Assoc. 2019 Jun 18;8(12):e012429.
7. Zheng W, Yu CM, Liu J, Xie WX, Wang M, Zhang YJ, et al. Patients with ST-segment elevation of myocardial infarction miss out on early reperfusion: when to undergo delayed revascularization. J Geriatr Cardiol. 2017;14(8):524–31.
8. Jortveit J, Pripp AH, Halvorsen S. Outcomes after delayed primary percutaneous coronary intervention vs. pharmaco-invasive strategy in ST-segment elevation myocardial infarction in Norway. Eur Heart J Cardiovasc Pharmacother. 2021;8(5):442–51.
9. Villalobos-Pedroza M, Hernandez-Pastrana S, Arias-Mendoza A, Latapi-Ruiz Esparza X, Robles-Ledesma M, Guerrero-Ochoa A, et al. Adherence to optimal medical therapy and control of cardiovascular risk factors in patients after ST elevation myocardial infarction in Mexico. Front Cardiovasc Med. 2024;11:1384684.
10. Dewi PEN, Rahajeng B, HImawan W, Thavorncharoensap M, Quang Trung Vo. The Effect of Covid-19 Pandemic on Treatment Management, and Clinical Outcome of Patients with Acute Coronary Syndromes (ACS): A Systematic Review and Meta-Analysis. Indones J Pharm. 2024 Dec 17;35(4):573–91.
11. Pec J, Buchner S, Wester M, Debl K, Hamer OW, Florian P, et al. Association of Coronary Collaterals and Myocardial Salvage Measured by Serial Cardiac Magnetic Resonance Imaging after Acute Myocardial Infarction. J Cardiovasc Dev Dis. 2023;10(12):473.
12. Xue YL, Ma YT, Gao YP, Zhang SX, Su QY, Li YF, et al. Long-term outcomes of delayed percutaneous coronary intervention for patients with ST-segment elevation myocardial infarction. Med Baltim. 2021;100(46):e27474.
13. Lee SH, Hyun D, Yoon CH, Cha KS, Oh S, Seong IW, et al. Adherence to guideline-directed medical therapy and 3-year clinical outcome following acute myocardial infarction. Eur Heart J Open. 2023;3(2):oean029.
14. Zhang W, Jia H, Zhao X, Song W, Sun W, Wang Q, et al. Predictive value of cumulative SII for MACE in STEMI patients after PCI. Med Baltim. 2025;104(13):e41983.
15. Spitzer E, Frei M, Zaugg S, Hadorn S, Kelbaek H, Ostojic M, et al. Rehospitalizations Following Primary Percutaneous Coronary Intervention in Patients With ST‐Elevation Myocardial Infarction: Results From a Multi‐Center Randomized Trial. J Am Heart Assoc. 2017 Aug 2;6(8):e005926.
16. National Institute for Health and Care Excellence (NICE). Quality Statement 6: Primary PCI for Acute STEMI [Internet]. 2020. Report No.: QS68. Available from: https://www.nice.org.uk/guidance/qs68/chapter/quality-statement-6-primary-pci-for-acute-stemi
17. Yang H, Luo L, Huang Z, Qian J, Ge J, Zheng Y. Association Between Patient and System Delays and In-Hospital Mortality in Primary PCI for STEMI: Findings from a Large, Nationwide Inpatients Sample. Am J Med. 2024;137(12):1227-1235.e8.
18. Kingma JG. Acute Myocardial Infarction: Perspectives on Physiopathology of Myocardial Injury and Protective Interventions. In: Cardiac Diseases - Novel Aspects of Cardiac Risk, Cardiorenal Pathology and Cardiac Interventions. London: IntechOpen; 2020.
19. Xiu WJ, Yang HT, Zheng YY, Ma YT, Xie X. Delayed PCI 12 Hours after the Onset of Symptoms Is Associated with Improved Outcomes for Patients with ST-Segment Elevation Myocardial Infarction: A Real-World Study. J Intervent Cardiol. 2019;2019:1–11.
20. Scholz KH, Maier SKG, Maier LS, Lengenfelder B, Jacobshagen C, Jung J, et al. Impact of treatment delay on mortality in ST-segment elevation myocardial infarction (STEMI) patients presenting with and without haemodynamic instability: results from the German prospective, multicentre FITT-STEMI trial. Eur Heart J. 2018;39(13):1065–74.
21. Ibanez B, James S, Agewall S, Antunes MJ, Bucciarelli-Ducci C, Bueno H, et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Eur Heart J. 2018 Jan 7;39(2):119–77.
22. Collet JP, Thiele H, Barbato E, Barthélémy O, Bauersachs J, Bhatt DL, et al. 2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Eur Heart J. 2021 Apr 7;42(14):1289–367.
23. Griffin A, Yildiz M, Bradley S, Jenna ES, Garcia S, Schmidt CW, et al. Frequency and outcomes of STEMI patients presenting between 12 and 24 h after symptom onset: Late-presenting STEMI. Catheter Cardiovasc Interv. 2023;101(1):1–10.